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Cancer Treatments

Cancer is very difficult to treat. Treatment plans involve consideration of many variables, including cancer type, stage of disease, and the general condition of patient. The objective may be to cure the cancer completely, to control the spread of cancer, or to relieve their symptoms. These treatment methods are the most common cancers:

Surgery

Surgery may be performed as a tool to help diagnose cancer or as a treatment method. A common form of diagnostic surgery is a biopsy, where the doctor takes a sample of tissue from the afflicted area and runs tests to determine if it is cancerous or not.

Surgery for cancer treatment involves the excision of cancerous cells and some of the adjacent tissues (to ensure that all of the cancer is removed). In addition to removing the cancer, your doctor is able to gather information during the surgery about your condition that can serve as an aid for evaluating further treatment options and chances of recurrence.

In most cases, the surgeon removes the tumor and some tissue around it. Removing nearby tissue may help prevent the tumor from growing back. The surgeon may also remove some nearby lymph nodes.

The side effects of surgery depend mainly on the size and location of the tumor, and the type of operation. It takes time to heal after surgery. The time needed to recover is different for each type of surgery. It is also different for each person. It is common to feel tired or weak for a while.

Most people are uncomfortable for the first few days after surgery. However, medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with the doctor or nurse. The doctor can adjust the plan if you need more pain relief.

Some people worry that having surgery (or even a biopsy) for cancer will spread the disease. This seldom happens. Surgeons use special methods and take many steps to prevent cancer cells from spreading. For example, if they must remove tissue from more than one area, they use different tools for each one. This approach helps reduce the chance that cancer cells will spread to healthy tissue.

Similarly, some people worry that exposing cancer to air during surgery will cause the disease to spread. This is not true. Air does not make cancer spread.

Chemotherapy

Chemotherapy is the use of medicines to destroy cancerous cells. The drugs are administered orally or through an IV injection. They then circulate in the bloodstream with the goal of reaching any parts of the body where the cancer may have spread.

More than half of all cancer patients receive chemotherapy treatment. Although there may be harsh side effects associated with this treatment, recent advances in medicine have allowed physicians to control and even prevent some of them, allowing patients to maintain a higher quality of life throughout treatment.

Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.

Depending on your type of cancer and how advanced it is, chemotherapy can:

Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.

Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.

Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:

Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.

Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.

Help radiation therapy and biological therapy work better.

Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).

Treatment schedules for chemotherapy vary widely. How often and how long you get chemotherapy depends on:

Your type of cancer and how advanced it is

The goals of treatment (whether chemotherapy is used to cure your cancer, control its growth, or ease the symptoms)

The type of chemotherapy

How your body reacts to chemotherapy

You may receive chemotherapy in cycles. A cycle is a period of chemotherapy treatment followed by a period of rest. For instance, you might receive 1 week of chemotherapy followed by 3 weeks of rest. These 4 weeks make up one cycle. The rest period gives your body a chance to build new healthy cells.

It is not good to skip a chemotherapy treatment. But sometimes your doctor or nurse may change your chemotherapy schedule. This can be due to side effects you are having. If this happens, your doctor or nurse will explain what to do and when to start treatment again.

Chemotherapy may be given in many ways.

Injection. The chemotherapy is given by a shot in a muscle in your arm, thigh, or hip or right under the skin in the fatty part of your arm, leg, or belly.

Intra-arterial (IA). The chemotherapy goes directly into the artery that is feeding the cancer.

Intraperitoneal (IP). The chemotherapy goes directly into theperitoneal cavity (the area that contains organs such as your intestines, stomach, liver, and ovaries).

Intravenous (IV). The chemotherapy goes directly into a vein.

Topically. The chemotherapy comes in a cream that you rub onto your skin.

Orally. The chemotherapy comes in pills, capsules, or liquids that you swallow.

Chemotherapy affects people in different ways. How you feel depends on how healthy you are before treatment, your type of cancer, how advanced it is, the kind of chemotherapy you are getting, and the dose. Doctors and nurses cannot know for certain how you will feel during chemotherapy.

Some people do not feel well right after chemotherapy. The most common side effect is fatigue, feeling exhausted and worn out. You can prepare for fatigue by:

Asking someone to drive you to and from chemotherapy

Planning time to rest on the day of and day after chemotherapy

Getting help with meals and childcare the day of and at least 1 day after chemotherapy

There are many ways you can help manage chemotherapy side effects. For more information, see the Side Effects At-A-Glance section.

Many people can work during chemotherapy, as long as they match their schedule to how they feel. Whether or not you can work may depend on what kind of work you do. If your job allows, you may want to see if you can work part-time or work from home on days you do not feel well.

Many employers are required by law to change your work schedule to meet your needs during cancer treatment. Talk with your employer about ways to adjust your work during chemotherapy. You can learn more about these laws by talking with a social worker.

The radiation may be delivered by a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy, also called brachytherapy).

Systemic radiation therapy uses radioactive substances, such as radioactive iodine, that travel in the blood to kill cancer cells.

About half of all cancer patients receive some type of radiation therapy sometime during the course of their treatment.

Radiation therapy kills cancer cells by damaging their DNA (the molecules inside cells that carry genetic information and pass it from one generation to the next. Radiation therapy can either damage DNA directly or create charged particles (free radicals) within the cells that can in turn damage the DNA.

Cancer cells whose DNA is damaged beyond repair stop dividing or die. When the damaged cells die, they are broken down and eliminated by the body’s natural processes.

Radiation therapy is sometimes given with curative intent (that is, with the hope that the treatment will cure a cancer, either by eliminating a tumor, preventing cancer recurrence, or both). In such cases, radiation therapy may be used alone or in combination with surgery, chemotherapy, or both.

Radiation therapy may also be given with palliative intent. Palliative treatments are not intended to cure. Instead, they relieve symptoms and reduce the suffering caused by cancer.

A radiation oncologist develops a patient’s treatment plan through a process called treatment planning.

The type of radiation therapy prescribed by a radiation oncologist depends on many factors, including:

The type of cancer.

The size of the cancer.

The cancer’s location in the body.

How close the cancer is to normal tissues that are sensitive to radiation.

How far into the body the radiation needs to travel.

The patient’s general health and medical history.

Whether the patient will have other types of cancer treatment.

Other factors, such as the patient’s age and other medical conditions.

A patient may receive radiation therapy before, during, or after surgery. Some patients may receive radiation therapy alone, without surgery or other treatments. Some patients may receive radiation therapy and chemotherapy at the same time. The timing of radiation therapy depends on the type of cancer being treated and the goal of treatment (cure or palliation).

Radiation therapy given before surgery is called pre-operative or neoadjuvant radiation. Neoadjuvant radiation may be given to shrink a tumor so it can be removed by surgery and be less likely to return after surgery.

Radiation therapy given during surgery is called intraoperative radiation therapy (IORT). IORT can be external-beam radiation therapy (with photons or electrons) or brachytherapy. When radiation is given during surgery, nearby normal tissues can be physically shielded from radiation exposure. IORT is sometimes used when normal structures are too close to a tumor to allow the use of external-beam radiation therapy.

Radiation therapy given after surgery is called post-operative or adjuvant radiation therapy.

Radiation therapy given after some types of complicated surgery (especially in the abdomen or pelvis) may produce too many side effects; therefore, it may be safer if given before surgery in these cases.

The combination of chemotherapy and radiation therapy given at the same time is sometimes called chemoradiation or radiochemotherapy. For some types of cancer, the combination of chemotherapy and radiation therapy may kill more cancer cells (increasing the likelihood of a cure), but it can also cause more side effects.

Hormonal Therapy

Hormonal therapy is used when the cancer's growth is spurred by the absorption of naturally occurring hormones in the body. These cancers affect hormone-sensitive tissues such as the prostate or the breasts. In these cases, your doctor may decide to limit or block hormone production by administering certain drugs, or he or she may opt for removing the organs that produce the hormone feeding the cancer. Like chemotherapy, hormone therapy is effective against cancers that have spread throughout the body.

Some cancers need hormones to grow. Hormone therapy keeps cancer cells from getting or using the hormones they need. It is systemic therapy.

Hormone therapy uses drugs or surgery:

Drugs: The doctor gives medicine that stops the production of certain hormones or prevents the hormones from working.

Surgery: The surgeon removes organs (such as the ovaries or testicles) that make hormones.

The side effects of hormone therapy depend on the type of therapy. They include weight gain, hot flashes, nausea, and changes in fertility. In women, hormone therapy may make menstrual periods stop or become irregular and may cause vaginal dryness. In men, hormone therapy may cause impotence, loss of sexual desire, and breast growth or tenderness.

Targeted Therapy

Targeted therapies are intended to target only the cancer cells while limiting damage to the surrounding normal cells. Conventional cancer therapies are unable to distinguish between cancerous cells and healthy cells. These side effects can be severe, significantly reducing the patient's quality of life and compromising their ability to continue with treatment. The intention of targeted therapies is to increase the effectiveness of cancer therapy and reduce the negative side effects often associated with whole-body treatments such as chemotherapy and radiation therapy.

Targeted cancer therapies interfere with cancer cell division (proliferation) and spread in different ways. Many of these therapies focus on proteins that are involved in cell signaling pathways, which form a complex communication system that governs basic cellular functions and activities, such as cell division, cell movement, cell responses to specific external stimuli, and even cell death. By blocking signals that tell cancer cells to grow and divide uncontrollably, targeted cancer therapies can help stop cancer progression and may induce cancer cell death through a process known as apoptosis. Other targeted therapies can cause cancer cell death directly, by specifically inducing apoptosis, or indirectly, by stimulating the immune system to recognize and destroy cancer cells and/or by delivering toxic substances directly to the cancer cells.

Once a target has been identified, a therapy must be developed. Most targeted therapies are either small-molecule drugs or monoclonal antibodies. Small-molecule drugs are typically able todiffuse into cells and can act on targets that are found inside the cell. Most monoclonal antibodies usually cannot penetrate the cell’s plasma membrane and are directed against targets that are outside cells or on the cell surface.

Candidates for small-molecule drugs are usually identified in studies known as drug screens—laboratory tests that look at the effects of thousands of test compounds on a specific target, such as Bcr-Abl. The best candidates are then chemically modified to produce numerous closely related versions, and these are tested to identify the most effective and specific drugs.

Monoclonal antibodies, by contrast, are prepared first by immunizing animals (typically mice) with purified target molecules. The immunized animals will make many different types of antibodiesagainst the target. Next, spleen cells, each of which makes only one type of antibody, are collected from the immunized animals and fused with myeloma cells. Cloning of these fusion cells results in cultures of cells that produce large amounts of a single type of antibody, or a monoclonal antibody. These antibodies are then tested to find the ones that react best with the target.

Before they can be used in humans, monoclonal antibodies are “humanized” by replacing as much of the nonhuman portion of the antibody as possible with human portions. This is done through genetic engineering. Humanizing is necessary to prevent the human immune system from recognizing the monoclonal antibody as “foreign” and destroying it before it has a chance to interact with and inactivate its target molecule.

Targeted cancer therapies give doctors a better way to tailor cancer treatment, especially when a target is present in some but not all tumors of a particular type, as is the case for HER-2. Eventually, treatments may be individualized based on the unique set of molecular targets produced by the patient’s tumor. Targeted cancer therapies also hold the promise of being more selective for cancer cells than normal cells, thus harming fewer normal cells, reducing side effects, and improving quality of life.

Nevertheless, targeted therapies have some limitations. Chief among these is the potential for cells to develop resistance to them. In some patients who have developed resistance to imatinib, for example, a mutation in the BCR-ABL gene has arisen that changes the shape of the protein so that it no longer binds this drug as well. In most cases, another targeted therapy that could overcome this resistance is not available. It is for this reason that targeted therapies may work best in combination, either with other targeted therapies or with more traditional therapies.

How Treatment Can Affect Eating

Cancer Treatment

How it Can Affect Eating

What Sometimes Happens: Side Effects

Surgery

Increases the need for good nutrition. May slow digestion. May lessen the ability of the mouth, throat, and stomach to work properly. Adequate nutrition helps wound-healing and recovery.

Before surgery, a high-protein, high-calorie diet may be prescribed if a patient is underweight or weak. After surgery, some patients may not be able to eat normally at first. They may receive nutrients through a needle in their vein (such as in total parenteral nutrition), or through a tube in their nose or stomach.

Radiation Therapy

As it damages cancer cells, it also may affect healthy cells and healthy parts of the body.

Treatment of head, neck, chest, or breast may cause:

Dry mouth

Sore mouth

Sore throat

Difficulty swallowing (dysphagia)

Change in taste of food

Dental problems

Increased phlegm

Treatment of stomach or pelvis may cause:

Nausea and vomiting

Diarrhea

Cramps, bloating

Chemotherapy

As it destroys cancer cells, it also may affect the digestive system and the desire or ability to eat.

Nausea and vomiting

Loss of appetite

Diarrhea

Constipation

Sore mouth or throat

Weight gain or loss

Change in taste of food

Biological Therapy (Immunotherapy)

As it stimulates your immune system to fight cancer cells, it can affect the desire or ability to eat.

Nausea and vomiting

Diarrhea

Sore mouth

Severe weight loss

Dry mouth

Change in taste of food

Muscle aches, fatigue, fever

Hormonal Therapy

Some types can increase appetite and change how the body handles fluids.

Changes in appetite

Fluid retention

Remember, there aren't any hard and fast nutrition rules during cancer treatment. Some patients may continue to enjoy eating and have a normal appetite throughout most of their cancer treatment. Others may have days when they don't feel like eating at all; even the thought of food may make them feel sick. Here are some things to keep in mind:

When you can eat, try to eat meals and snacks with sufficient protein and calories; they will help you keep up your strength, prevent body tissues from breaking down, and rebuild tissues that cancer treatment may harm.

Many people find their appetite is better in the morning. Take advantage of this and eat more then. Consider having your main meal of the day early, and have liquid meal replacements later on if you don't feel so interested in eating.

If you don't feel well and can eat only one or two things, stick with them until you are able to eat other foods. Try a liquid meal replacement for extra calories and protein.

On those days when you can't eat at all, don't worry about it. Do what you can to make yourself feel better. Come back to eating as soon as you can, and let your doctor know if this problem doesn't get better within a couple of days.

Try to drink plenty of fluids, especially on those days when you don't feel like eating. Water is essential to your body's proper functioning, so getting enough fluids will ensure that your body has the water it needs. For most adults, 6-8 cups of fluid a day are a good target. Try carrying a water bottle with you during the day. That may help you get into the habit of drinking plenty of fluids.